Vaginal Atrophy & Incontinence
Vaginal atrophy and some incontinence problems (together know as Urogenital Atrophy) often result from declining oestrogen levels in these tissues. The importance of oestrogen on vaginal health is explained here.
For the urinary canal, oestrogen is important in maintaining the lining of the urethra and for the strength and tone in the muscles which support and control urine leakage, including the pelvic floor. The lack of oestrogen during menopause often exacerbates existing damage that may have occurred as a result of pregnancy, childbirth or other factors. The pelvic support structures also relax due to the natural ageing process.
Vaginal or Urogential Atrophy affects many women of different ages. The most common cause is the decrease in oestrogen that happens naturally during perimenopause, and increasingly so in post-menopause, with up to 50 percent of these women reported to be affected. However, younger women can also experience the same symptoms, at an earlier age than expected. Any woman at risk of being in a low-oestrogen state can be affected, including women with:
- Prolonged contraceptive use where taking progesterone only pills (such as the mini-pill) or medroxyprogesterone injections (such as Depo-Provera)
- Prolonged breastfeeding
- Premature menopause states such as primary ovarian failure
- Induced menopause secondary to cancer treatment, particularly breast cancer – chemotherapy, radiation therapy, Tamoxifen, aromatase inhibitors
- Induced menopause secondary to surgery – removal of ovaries for treatment of ovarian cancer or for prophylactic treatment in women with increased risk.
Symptoms of Vaginal or Urogential Atrophy
- The tissues of the vulva and the lining of the vagina to become thinner, drier and less elastic or flexible, often leading to inflammation or the vagina (and the outer urinary tract) known as atrophic vaginitis
- Vaginal widening or loosening of the vaginal canal and a loss of muscle tone and tissue elasticity in the vagina, known as laxity. A loss of sensation and discomfort upon penetration often makes sex unappealing for women suffering from vaginal atrophy
- An increase in vaginal pH, which makes the vagina less acidic. A healthy vagina has a slightly acidic pH, which encourages the presence of healthy bacteria known as lactobacilli. Without this low pH, “bad” bacteria can increase causing vaginal discharge with an unpleasant odour and colour and increase occurrence of thrush
- The change in pH can also cause a persistent vaginal discharge, usually malodorous
- The external genital tissue thins and may darken in colour
- Recurrent urinary tract infections
- Up to 50 percent of women describe stress (or urge) incontinence – the accidental loss of urine caused by weak pelvic floor muscles, particularly during coughing, sneezing, laughing, lifting or exercise
- Supporting muscles of the bladder, uterus and bowel can also become weakened and a prolapse into the vagina can result
Unlike some low oestrogen symptoms such as hot flushes, vaginal or urogenital atrophy does not tend to resolve with time but instead persists and can worsen, causing a consequent decline in quality of life.
Further, when these symptoms hinder a womans desire to engage in regular intercourse, her vagina can also become shorter and narrower. This results in further pain and discomfort when she does attempt sexual activity (known as dyspareunia). Pain is due to the now dry and fragile vulvovaginal tissues that are susceptible to injury, tearing and even bleeding during intercourse or any penetration of the vagina. The resulting discomfort can be so severe that the woman avoids intercourse entirely which, in turn, worsens the condition and may have an adverse impact on personal relationships.
However, many women still feel uncomfortable discussing their symptoms with others, including their own doctor, possibly because it is naturally caused, or because of the taboo that still exists surrounding aging and sexuality. It is important for a woman to realise that these symptoms are common and treatable.
For a woman about to undergo medical and surgical treatment that could induce menopause, it is important for her to feel confident to discuss the expected outcomes of treatment and how this will impact on her body and femininity. Women should make informed decisions about their symptoms and available treatments: Knowledge is power!